Policy: Entitlements

Alternatives eyed for Medicaid expansion in Nebraska

Associated Press,Nebraska,Health Care,Medicare and Medicaid,Entitlements

LINCOLN, Neb. — Lawmakers who want to expand Medicaid in Nebraska are reworking their proposal and likely will borrow from other state plans that have won bipartisan support, a key state senator said Wednesday.

State Sen. Kathy Campbell of Lincoln said she will introduce a new version of the bill, dubbed the "Nebraskan plan," to try to win support from skeptical colleagues in the Legislature. An attempt to extend Medicaid coverage as part of the federal health care law stalled earlier this year in a legislative filibuster, and was opposed by Gov. Dave Heineman.

On Wednesday, the Legislature's Health and Human Services Committee reviewed plans that were developed in Arkansas, Iowa, Michigan and Pennsylvania. Several of the proposals seek to use federal Medicaid dollars to purchase private health insurance for low-income residents. They also required federal approval. The U.S. Department of Health and Human Services has promised to work with states that want to customize their own plans.

Iowa's proposal calls for a state-run plan for people below the federal poverty line, while using federal dollars to buy private insurance for those who make up to 138 percent of the federal poverty level. Republican Gov. Terry Branstad, who staunchly opposed the health care law, agreed to soften his stance if he received assurances that state taxpayers wouldn't end up with the bill.

The plan was modeled after a "private option" proposal in Arkansas, which was endorsed by both the Republican-led Legislature and Democratic Gov. Mike Beebe as an alternative to expanding Medicaid.

Had it passed this year, the Nebraska measure would have extended coverage to an estimated 54,000 low-income, childless adults. Supporters said the failure to approve it will create a "coverage gap" of 32,570 residents whose incomes are too high to qualify for the current Medicaid program, but too low to receive federal tax credits available under the health insurance exchanges.

That uninsured population has started showing up at Nebraska health clinics. Rebecca Rayman, the director of the East-Central District Health Department in Columbus, said one of her clients has struggled to find coverage because his income as a farm worker varies. He makes $4,000 a month during the busy farm season but substantially less in the winter months, so he falls into the gap.

"Now, he finds himself at 59, concerned about his future," Rayman said. "He has about six years of farm labor before he's old enough for Medicare. After years of hard farm work, he's very concerned about his future. He's very concerned about his body's ability to keep up with the farm work that's all he's ever known."

Tammy Fiechtner, a western Nebraska rancher from Stapleton, told lawmakers that she and her husband would also fall into the coverage gap without the expansion. Fiechtner said her current plan was canceled because it didn't meet the federal health care law's requirements, and the couple doesn't qualify for health-care marketplace subsidies or Nebraska's existing Medicaid plan.

"It's western Nebraska's personal story," she said. "We're hard working people and we've been forgotten."

The Medicaid expansion was originally required under the health care law, but the U.S. Supreme Court ruled the federal government couldn't penalize states that refuse to participate.

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